ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Epidemiology and Prevention
This article is part of the Research TopicCancer Burden and Cancer Screening Strategies in AsiaView all 6 articles
Effect of colonoscopy screening on the risk of colorectal cancer in China: a follow-up study
Provisionally accepted
Yunxin Kong1
De Liu2Yue Ma1Zongmei Dong2Yiran Wang1Xiaohu Luo1Hongying Zhao1Rui Jin3Siyuan Gao3
Guihua Zhang1Dong Dong1*Pan Zhang2*
Lang Zhuo3*- 1Xuzhou Cancer Hospital, Xuzhou, China
- 2Xuzhou Center for Disease Control and Prevention, Xuzhou, China
- 3Xuzhou Medical University, Xuzhou, China
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ABSTRACT Background: Colorectal cancer (CRC) is one of the most common cancers worldwide. Colonoscopy is the gold standard for CRC screening, but its effectiveness in population-based programs requires further evaluation. Methods: We conducted a follow-up study in Xuzhou, China. Participants were recruited from 2014 to 2021, with follow-up continuing until December 2023. The study comprised two components: 1) an active follow-up to assess treatment outcomes for patients with colorectal advanced neoplasia (CAN) detected during screening; 2) a passive follow-up to compare CRC incidence and mortality between participants who underwent colonoscopy and those who refused it. Results: The the active follow-up included 196 participants, while 15,440 were included the passive follow-up (4,029 in the colonoscopy group and 11,411 in the non-colonoscopy group). 96.43% (189/196) CAN patients were actively followed. However, only 25.93% (49/189) received treatment. The CRC incidence density was 35.77 per 100,000 person-years in the colonoscopy group, which was significantly lower than the 95.50 per 100,000 in the non-colonoscopy group (IRR=0.37, P=0.011). 83.33% (5/6) of the CRC cases in the colonoscopy group were from the subgroup of CAN patients who did not receive treatment. There was no significant difference in CRC mortality between the two groups. Conclusions: Colonoscopy screening is effective in reducing the risk of CRC. However, its real-world effectiveness has been compromised by the low participation rate and the poor treatment adherence among screen-positive patients. The impact of
Keywords: Colorectal neoplasm, Mass Screening, Colonoscopy, Incidence, Mortality
Received: 20 Aug 2025; Accepted: 30 Oct 2025.
Copyright: © 2025 Kong, Liu, Ma, Dong, Wang, Luo, Zhao, Jin, Gao, Zhang, Dong, Zhang and Zhuo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Dong Dong, ddong2002@163.com
Pan Zhang, 297166200@qq.com
Lang Zhuo, zhuolang@xzhmu.edu.cn
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